Tag Archives: respect

I don’t only ask this question of women whom I suspect of being abused at home. I also ask my medical assistants. Not about their domestic partners, but about our patients.

In my first practice, I sat/stood to the left of my medical assistant every day for six years. It was a cozy (cramped) little counter space stacked with charts from end to end, with a couple of high-wheeley chairs. Each chart stack had a laminated cover on top: “For Cheng to Review/Sign,” “For Rose,” “Labs,” and “Messages.” Charts journeyed from my left to my right/Rose’s left, to the bin under the counter to be filed. It was incredibly efficient, actually. I had a handwritten emoji system for indicating (dis)satisfaction with cholesterol and diabetes results. Rose knew all of my patients and how to communicate sentiments and instructions clearly and lovingly. She had been an MA since I was a kid; she knew what she was doing. If a patient had a question on the phone, she could put them on hold and clarify with me, or I could just get on the phone and speak to the patient myself. We were busy and happy, a well-oiled team-machine.

One day as I came up to my spot at the counter, I noticed an unusual sound next to me, like a distant, scratchy loudspeaker. I turned and saw Rose holding the phone receiver about an inch from her ear. The sound was my patient, yelling profanities at her so loudly I could hear his words from two feet away. I can’t remember what the issue was, but he was obviously upset, and taking it out on her. It surprised me because I had only known him to be sweet, respectful, and grateful. Maybe he was just having a bad day? I looked at Rose, who rolled her eyes and exhaled heavily. I asked her to put him on hold so she could catch me up. Apparently this had been going on longer than I knew, and she had not told me. Had I not come upon it in real time, she may never have told me. She would have simply tolerated it.

I picked up the call and declared myself. He was the usual, respectful and calm patient I had always known. I answered his medical questions. Then I told him firmly that he did not have the right to treat anyone in my office the way he had just treated Rose. I think there may have been some excuses and then an apology. I made it clear that if he abused my team again, he would be discharged from the practice. He agreed and apologized again.

That was my first opportunity to stand up for my team as an attending. I will forever remember it. I was a petite, young, Chinese woman doctor, speaking to a white man decades older than myself. I stood up for my medical assistant, a woman of color and a couple decades older than me. She had felt powerless to stand up for herself to his verbally vomitous abuse. All I had to do was pick up the phone and say, “Mr. Soandso, this is Dr. Cheng.” He never yelled at Rose or anyone in the office again, to my knowledge. How could I have this much power, and why had nobody asked me to wield it in their defense before? It was just accepted that patients could yell and scream at our staff, with no consequences?

We recently discussed abusive patients during our regular doctors’ meeting at my current practice. Immediately I thought, HELL NO. The good news was that our team members feel safe reporting incidents to our managers and physicians. My partners and I have all had to call patients to clarify our expectations of respect. We understand that illness is stressful. We understand that our healthcare system, especially at a large, bureaucratic institution, causes frustration, even rage. However, none of that ever justifies or entitles a patient, or anyone, to belittle, dehumanize, or otherwise degrade another person, and especially not a team member who is doing their best to help–ever. At this meeting, gratifyingly, we all voiced definitive confirmation that we fully support our team, and we will, without hesitation, educate and/or discharge any patient who violates our team’s right to a collegial and non-threatening work environment.

Even as I write this, I shake a little with rage and outrage at these patients’ behavior. I can feel tightness and tension in my chest and abdomen, my breath quicker and shallower than its usual resting state. I wonder if this triggers me because my mom is a nurse and I have seen how patients in the hospital abuse nurses. I also know how women physicians are mistaken for nurses and thus ignored or dismissed, even by female patients. I have known racism and sexism first hand. But as a physician, I’m in a position to not have to tolerate it. By virtue of two letters after my name, I have the power to protect my team, with authority. And I work with other physicians who also recognize both this power and its attendant responsibility.

I hope our team feels protected, defended, and loved by us docs. We may be the default work unit leaders, but they do the lion’s share of work that allows our practice to run as smoothly and successfully as it does. They are who let me do my work as well as I do. I depend on them every day. So caring for them absolutely makes me better, makes us all better.

Not that I have anything against Thanksgiving… I just have difficulty pouring forth a great gush of gratitude every fourth Thursday of November for a national holiday. I thought this week it was just because of the tensions of the year, but looking back, I’ve never really loved this day. I feel sheepish to write it, like people will think less of me. Then again, something tells me I might not be the only one?

Yesterday I shared the most eloquent treatise on gratitude I have ever read, and I believe every word. I try to live the premise every day—to pay attention and feel gratitude at the deepest cosmic level, connected to everything in the universe. I marvel every day at all that I have, all that I am privileged to witness and do—to live this life, so full of learning and connection. Today I’m supposed to summon and articulate all that moves me to thankfulness… Why do I resist?

I imagine many would read this and think, “Wow, she is so ungrateful,” or maybe un-American? I think most people who know me would disagree. And those who know and love me best would hold the space with me to explore the curiosity of it all, without judging me for it or trying to ‘fix’ it. And I’m ever so grateful for them, because I’m not sure it’s something that needs to be ‘fixed.’

I think it’s okay to feel not particularly grateful today, no more than any other day. I also think it’s okay to feel especially grateful on this day, significantly more than any other day. What’s not okay—what I see causing so many people to suffer—is when we shame others for thinking and feeling differently from us. We physicians do this more than we realize, I think. When patients don’t seem to take blood pressure, diabetes, obesity, or flu as seriously as we do, we can get very judgmental. When they have different ideas about what will make them better (natural supplements, unusual diets, acupuncture, shamanic journeying, homeopathy), we can become positively hostile. This is rarely helpful.

So if you, like me, are not particularly into Thanksgiving, and/or if you don’t subscribe to all conventional wisdom around certain things medical, I will try to withhold judgment. I am indeed grateful for the chance to gather and enjoy one another’s company this week. I don’t advertise my apathy for the holiday, as that would diminish others’ joy—and that would be antithetical to my core values. I also appreciate the freedom to celebrate modestly rather than exuberantly. I respect your right to choose therapies according to your values and beliefs, as long as your choices do not harm others.

I’ll continue to explore my relative indifference toward Thanksgiving. Thank you for not trying to make me feel bad for it.

I have very specific behaviors in mind here. I’m not talking about the inevitable frustrations that we all face in over-scheduled clinics and understaffed hospitals. Exasperation, disappointment, and even anger are appropriate emotions we all share. We understand that you may make surly faces and splutter a little when your expectations are not met. Most medical staff are trained and expected to handle such interactions with patience, compassion, and calm. They are frequently also given only narrow parameters within which to convey information, and almost no decision-making authority or autonomy. Believe me, they feel terrible when they cannot help you, and often there really is nothing they can do in the moment. But they can always ask for help, so I respectfully request that you give them the time and space to do so.

The medical community has a lot of work ahead to integrate our care teams. We serve you best when all team members are empowered to exercise their best judgment, within their scope of practice, to move care forward toward your best health. We are all here doing our best. Physicians play a crucial role in both local and global medical culture. But we are only recently stepping up as actively collaborative leaders, rather than authoritarians and paternalists. You may see us physicians abusing our own staff, so let me be clear again: That is also definitely not okay. Never mind that it undermines morale. It can also endanger patients. I hope in my lifetime to see an end to this contemptible behavior.

If I witness you abusing my staff, be sure that I will call you out. I will do it respectfully, even lovingly, especially when I know you’re going through a hard time. I understand how hard it is to control our emotions when we’re unwell and frightened. It’s good for all of us, however, to know exactly where the boundaries of acceptable behavior and language lie. Expect that if you cannot abide them, I will ask you to leave.

If you witness me or my colleagues abusing our staff, we need you to call us out, too. Relationships are never one direction. In medicine and health, the webs of connection are inextricable—one person’s mood and attitude can rapidly infect a group—and the stakes can be high. I expect myself and my staff to conduct ourselves professionally. We expect you to behave humanely.